Date of Filing:23/10/2014

     Date of Order:26/04/2016

BEFORE THE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SHANTHINAGAR BANGALORE -  27.

Dated: 20^TH DAY OF APRIL 2016

PRESENT

SRI.SYED ANSER KHALEEM, B.SC., B.Ed.,LL.B.,PRESIDENT

SRI.H.JANARDHAN,B.A.L, LL.B., MEMBER

SMT.BHARATI.B.VIBHUTE, B.E(I.P.) LL.B., MEMBER

COMPLAINT NO.1789/2014

Mr Srinivasa,

S/o Late Shri Krishnappa,

Aged : Major,

Residing at  Door No.2791,

13^th Main, E Block,

Rajajinagar,

Bangalore-560 002.                                …. Complainant

V/s

The Managing Director,

Manipal Hospital North

Side Hospital,

Malleshwaram,

Bangalore- 560003.                      …. Opposite Party    

ORDER

BY SMT.BHARATI.B.VIBHUTE, MEMBER

1.     The complainant has filed this complaint U/S 12 of the Consumer Protection Act, 1986 against the opposite parties (hereinafter referred in short as O.P) alleging deficiency in service on the part of the O.P and prays for direction to the O.P to issue bifurcated invoice towards the amount paid by cash and the amount paid by the Insurance company, to pay Rs 1,00,000/- as compensation for mental tension, harassment and agony and the cost of the proceedings.

2.   The brief facts of the complaint is that, on 1^st November 2013 the complainant’s wife Smt Girija.K was got admitted to the Manipal North Side Hospital, Malleshwaram, Bangalore for surgery and the I.P No is 40609. The O.P issued bill for a sum of Rs 1,44,198/- towards surgery. The complainant was paid Rs.61,237/- out of the billed amount of Rs 1,44,198/- through a Medical Insurance Claim under (Medi Assist) and for  balance amount of Rs 82,961/-, the complainant has requested the O.P to adjust against the KPCL Retired  Health Scheme Insurance and he also submitted the original letter of cash less payment confirmation from the above mentioned Department to the O.P.

3.     The wife of the complainant got discharged on 16-11-2013. On the day of discharge was a weekend day and the office of the KPCL retired Employees Scheme Insurance was not working and therefore he could not get confirmation from the office. However the person incharge for billing wanted to telephonically confirm the letter issued by KPCL retired Employees Scheme Insurance. The complainant asked the O.P to wait for two days for discharging his wife. The complainant for his inconvenience in hospital got his  wife discharged by paying remaining balance of Rs 82,961/- by cash.

4. Thereafter the complainant approached the KPCL retired Employees Scheme Insurance for reimbursement of the amount, they requested the complainant to furnish bifurcated invoices for cash paid by the complainant to the O.P, so that they can reimburse the cash paid.  However the O.P refused to provide the bifurcated bill and also refused to give endorsement that the complainant paid the part bill by cash. The complainant has issued a legal notice but the O.P did comply to the legal notice. Hence this complaint.

5.      Upon issuance of notice, O.P serving of notice did not appear in order to contest the case and thereby O.P. is placed exparte.

6.     To substantiate the above case, the complainant has filed the affidavit evidence along with documents.  We have heard the arguments.

7.     On the basis of pleadings of the complainant, the following points will arise for our considerations are:-

                                (A)    Whether the complainant has proved

                        deficiency in service on the part of the O.P?

(B)    Whether the complainant is entitled to the

         relief prayed for in the complaint?

(C)    What order?

8.     Our answers to the above points are:-

POINT (A) and (B) :  Affirmative.

POINT (C):  As per the final order

for the following:

REASONS

POINT  No (A) and B:-

9.     On perusal of the pleading as well as the documents produced along with the complaint, it reveals that the wife of the complainant got admitted to the Manipal North Side Hospital on 01.11.2013 for surgery.  The complainant incurred medical expenditure of Rs.1,44,198/- out of which the complainant initially paid Rs.61,237/- and due to non-honoring of the claim by the internal insurance of the department well in time the complainant himself paid remaining balance amount of Rs.82,961/- and got discharged his wife from the hospital on 16.11.2013. The grievance of the complainant is that, the insurance company required to honor the claim bifurcated invoice for insurance amount in order to claim remaining balance amount of Rs.82,961/-.On perusal of the legal notice dated 20.2.2014 it is evident that when the O.P did not yield to the request of the complainant in order to issue bifurcated invoice and the complainant got issued the legal notice. The O.P. being the service provider the complainant has got all liberty to claim under the insurance, the O.P cannot deprive his legitimate claim and non-issuing the bifurcated invoice in order to claim insurance amount, it obviously leads  to deficiency in service on the part of the O.Ps. On issuing the bifurcated invoice which is required for the complainant in order to claim the amount in question, no hardship will caused to the O.P. but the O.P for the reasons best known to him did not issue the same.  In the attendance circumstances of the case we deem it just and proper to direct the O.Ps to issue bifurcated invoice to the complainant as claimed in order to meet the ends of justice.  The non-issuance of bifurcated invoice made the complainant to wander from pillar to post.  Hence, the O.P shall pay cost of the proceedings also. Accordingly, we answered these points in the affirmative.

POINT (C):

10.   On the basis of the findings given above on the point No.(A) and (B) and in the result, we proceed to pass the following:-

ORDER

1. The complaint is allowed-in-part with cost.

2. The O.P i.e. Manipal North Side Hospital represented by its Managing Director/Authorized Signatory is hereby directed to issue bifurcated invoice to the complainant towards the medical expenditure incurred for surgery of the complainant’s wife.

3. Further O.P is directed to pay Rs.2,000/- to the cost of the proceedings.

4. The O.P is hereby directed to comply the order of this Forum within 30 days from the date of receipt of this order and submit the compliance report to this forum within 45 days from the date of receipt of this order.

5. Send a copy of this order to both parties free of cost.

(Dictated to the Stenographer, transcribed and computerized by him, corrected and then pronounced by us in the Open Forum on this the 20^th Day of April 2016)

MEMBER                 MEMBER                PRESIDENT

*Rak